Specific features of rehabilitation in patients with gluten-sensitivity celiac disease


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AIM: To elaborate recommendations for rehabilitation of patients with gluten-sensitivity celiac disease (GCD) on the basis of a long-term follow-up/MATERIAL AND METHODS: Eighty-seven patients with GCD were followed up for as long as 31 years. Of those, 72.4% of the patients kept strictly to their gluten-free diet (GFD) throughout the follow-up; 9.2% did not follow the diet periodically; and 18.4% did not at all. The sera from 71 patients were tested for IgA and IgG anti-gliadin antibodies (AGAb) and anti-tissue transglutaminase antibodies (AтTGAb) at as long as 19-year follow-up. AGAb and AтTGAb were estimated by enzyme immunoassay (IMMCO Diagnostics). All the patients underwent endoscopic and histological examinations of the small bowel mucosa (SBM)/RESULTS: To support the validity of keeping to the GFD, the time course of clinical, laboratory, and morphological changes were analyzed in 63 and 24 GFD followers and non-followers, respectively. The GFD non-followers were more frequently found to have diarrheic syndrome, symptoms of malabsorption syndrome, lower serum concentrations of hemoglobin, total protein, iron, and calcium; no SBM structural recovery was seen in any patient. When the GFD was long adhered to, there was also a reduction in detection rates and AGAb and AтTGAb concentrations/CONCLUSION: The adherence to the GFD was ascertained to contribute to fuller rehabilitation in the patients. However, even the patients who had strictly kept to their GFD showed periods of an exacerbation and incomplete SBM structural recovery. Therefore, the rehabilitation system for patients with GCD must involve diagnostic, therapeutic, and organizational measures that promote not only rapid clinical recovery, but also better quality of life in these patients.

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Особенности реабилитации больных глютенчувствительной целиакией. - Резюме. Цель исследования. Разработать рекомендации по реабилитации больных глютенчувствительной целиакией (ГЦ) на основании длительного динамического наблюдения. Материалы и методы. Провели динамическое наблюдение за 87 больными ГЦ в сроки до 31 года. Из них 72,4% больных тщательно соблюдали аглютеновую диету (АГД) в течение всего периода наблюдения, 9,2% - периодически нарушали, а 18,4% - вовсе не соблюдали. В сыворотке крови у 71 больного определяли антитела к глиадину (АГА) и тканевой трансглутаминазе (АтТГ) классов IgА и IgG в сроки наблюдения до 19 лет. АГА и АтТГ оценивали иммуноферментным методом (IMMCO Diagnostics). У всех больных проводили эндоскопическое и гистологическое исследование слизистой оболочки тонкой кишки (СОТК). Результаты. Для подтверждения обоснованности соблюдения АГД проанализирована динамика клинических, лабораторных и морфологических показателей у 63 больных, соблюдающих, и 24 не соблюдающих АГД. В группе больных, не соблюдающих АГД, чаще наблюдали диарейный синдром, симптомы синдрома нарушенного всасывания, снижение концентраций гемоглобина, общего белка, железа и кальция в сыворотке крови; ни у одного больного не наблюдалось восстановления структуры СОТК. При длительном соблюдении АГД также отмечалось снижение частоты выявления и концентрации АГА и АтТГ. Заключение. Установлено, что соблюдение АГД способствует более полной реабилитации больных. Однако даже у больных, строго соблюдающих АГД, наблюдались периоды обострения и неполное восстановления структуры СОТК. Поэтому система реабилитации больных ГЦ должна включать диагностические, терапевтические и организационные мероприятия, которые будут способствовать не только клиническому выздоровлению, но и улучшению качества жизни больных ГЦ.
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